Full Transcript for Leading with Kindness | Quality Time with Dr. Schaal

leaders over at least seven decades that have put this together. 00:06:27.653 --> 00:06:48.540 And one of the fascinating things about this is that it's not just our mental health that is affected by all of these drivers of burnout or moral injury or distress, it affects, equivalently, both our physical and our mental health because the pathways are the same. 00:06:48.608 --> 00:06:58.651 So we think that well, diet and exercise, well that's good for our body, it is, they are, if we do them the right way they affect our mental health equivalently. 00:06:58.718 --> 00:07:14.065 And we think about kindness and compassion, and awe, and those emotions that we can experience as humans have an equivalent impact on our physical health just beyond our mental wellbeing. 00:07:11.697 --> 00:07:14.065 So it's fascinating. 00:07:14.132 --> 00:07:32.485 So I hear, in my role here, one of my roles here is that I'm the CEO of our physician organization and certainly I would like our physician organization to be the best place that any physician or any other clinician would like to be part of. 00:07:32.552 --> 00:07:38.357 And part of it is to really focus on wellness of our clinicians. 00:07:38.423 --> 00:07:50.435 And you authored this book that says there are 12 actions that I can take as a leader, or the organization can take as a leader to create the ideal workplace. 00:07:50.502 --> 00:07:52.872 And I love the word ideal. 00:07:52.939 --> 00:07:56.908 Can you tell me a little bit about what it means and what I need to do? 00:07:56.975 --> 00:08:01.646 So ideal is aspirational and it's like perfection. 00:08:01.713 --> 00:08:09.254 And we never get to perfection, we never get to ideal, but that should be our North Star, that should be what we aspire to. 00:08:09.322 --> 00:08:17.863 And so we wanna always be in that space between excellence and perfection and ideal, understanding what ideal would be. 00:08:17.930 --> 00:08:26.572 Because we work in a system with human beings and with man-made, human-made structures it will necessarily be imperfect. 00:08:26.639 --> 00:08:36.682 But the ideal would be some combination of four elements that have been described and validated over the last 70 years. 00:08:34.413 --> 00:08:36.682 Agency. 00:08:36.749 --> 00:08:43.355 Agency means having some control over one's life and specifically our work life. 00:08:43.422 --> 00:08:57.970 You know, we spend -- Except for sleeping, we spend more time in our lives at work than we do any other activity, so we should be as well and have ideal characteristics of our work life as we do in the rest of our life. 00:08:58.037 --> 00:09:00.105 So agency is a key. 00:09:00.172 --> 00:09:10.515 One large epidemiology study including Marmot in Great Britain showed that people who had control over their lives they live longer and they had a positive and more positive life assessment. 00:09:10.582 --> 00:09:26.399 So that's one that we can certainly work with in how we make decisions and how we govern and how we select our leaders and how those leaders work with staff to make decisions together, and it's not just a top-down deal. 00:09:26.465 --> 00:09:33.773 You know, if you were designing the ideal symphonic orchestra, you'd want an outstanding conductor. 00:09:33.839 --> 00:09:38.076 But could you imagine what it would be like that conductor never played the violin? 00:09:38.144 --> 00:09:59.197 So part of agency is feeling -- you look up and you work with someone and you have trust in them and you can do that if you never played the violin, but it's a lot easier and better if a practicing nurse is leading nurses and a practicing physician is, or at least someone who's had experience as a physician is leading physicians. 00:09:59.264 --> 00:10:04.070 And that's one of the first foundational stones of agency. 00:10:04.135 --> 00:10:05.671 And what are the other three? 00:10:05.738 --> 00:10:09.708 So, belongingness is a -- I love that word, belongingness. 00:10:09.774 --> 00:10:32.365 And it's basically -- Humans are social animals and creatures and beings and having -- being part of a community that accepts you for who you are and loves you and cares for you in spite of who you are or what you did is a very important piece of wellbeing in life and specifically at work. 00:10:32.431 --> 00:10:41.774 And leader behaviors play a central role in having all of our staff, regardless of phenome or genome feel like they belong. 00:10:41.841 --> 00:10:55.788 Third is -- You could -- I say this different ways, but my favorite way is a term from Emile Durkheim, he's one of the founders of sociology 100 years ago in France. 00:10:55.855 --> 00:11:02.094 It talked about this feeling of collective effervescence, collective effervescence. 00:11:00.158 --> 00:11:02.094 Isn't it beautiful? 00:11:02.160 --> 00:11:04.363 I love the word effervescence. 00:11:04.429 --> 00:11:05.697 It's bubbly, right? 00:11:05.764 --> 00:11:14.072 It is bubbly, yeah, and that's how we want to all feel at work and we wanna -- And at work, the collective piece is it's part of a team. 00:11:14.139 --> 00:11:27.119 So collective effervescence is the harmony, the energy, the meaning when a group of people come together with a shared purpose. 00:11:27.186 --> 00:11:48.006 And that's what we want our work in hospitals and clinics and home care and community care to feel like, that we're a team, we have a shared purpose, we have this energy and excitement and we have this meaning in our work from the shared purpose we do together. 00:11:48.073 --> 00:11:59.451 And you could experience that by yourself but the ideal at work and in life is we experience it with our family or a loved one, or our work team. 00:11:59.518 --> 00:12:01.453 And such collective effervescence. 00:12:01.519 --> 00:12:08.094 And the fourth of these ideal work conditions or traits that all of them are evidence based. 00:12:08.159 --> 00:12:15.167 All of them have large epidemiology studies, some

experimental studies, some observation studies. 00:12:15.234 --> 00:12:19.839 And so positivity is the fourth. 00:12:19.904 --> 00:12:24.176 And a lot of people roll their eyes when they think about, well positivity. 00:12:24.243 --> 00:12:32.418 "Well, yeah, let's just get the work done and enough of this Pollyanna stuff." There are four very large epidemiology studies. 00:12:32.485 --> 00:12:45.331 One with nuns, one with nurses, one with veterans of wars, one at Mayo Clinic cross sectional, epidemiology study at Mayo Clinic. 00:12:45.397 --> 00:13:09.187 All four of them showed that people who in their lives had a positive life environment their affect tended towards positivity, their disposition was predisposed to optimism, they live longer. 00:13:09.254 --> 00:13:14.192 And their life assessment, through their own assessment, was more positive. 00:13:12.258 --> 00:13:14.192 They're subjective. 00:13:14.259 --> 00:13:29.307 So, like all four of these traits, they affect our physical and mental health, and there are ways that we as leaders can help nurture and cultivate each of these four ideal work attributes. 00:13:29.375 --> 00:13:32.878 So let's talk a little bit more, kind of in depth about that. 00:13:32.945 --> 00:13:36.115 So, let's start with agency and control. 00:13:36.182 --> 00:13:42.988 You know, I'm a clinician scientist and in science you actually have more control over your schedule, you know. 00:13:43.054 --> 00:13:49.427 You can start experiments at 9:00, you know, instead of 7 a.m. 00:13:49.495 --> 00:13:58.403 You can decide, you know, I'm going -- Yes there are deadlines but you can decide what, you know, grant you're gonna submit and what grant you're not going to submit. 00:13:58.470 --> 00:14:05.376 But for physicians and specifically for surgeons, you know, the OR starts a specific hour. 00:14:05.443 --> 00:14:09.881 There's, you know, patients that are waiting for you and you gotta see them all. 00:14:09.948 --> 00:14:21.059 And there's this continuous monitoring of actually what you're doing that you can't just say,"You know what? 00:14:21.125 --> 00:14:27.633 I'm gonna change the clinic and I'm gonna see only four patients today." There are 20 waiting for you today. 00:14:27.700 --> 00:14:28.667 You have to see them all. 00:14:28.734 --> 00:14:31.537 You can't just take off. 00:14:28.734 --> 00:14:31.537 It's not under your control. 00:14:31.604 --> 00:14:47.686 So how do we as organizations that employ physicians and think, obviously, about our patients who need to be served, how do we insert a little bit more agency and a little bit more control into our clinicians lives? 00:14:47.753 --> 00:14:58.163 So, I think some elements of the ideal decision making and governance is a model that engages all the staff in that work group. 00:14:58.230 --> 00:14:59.697 So we're talking about physicians. 00:14:59.764 --> 00:15:15.813 Ideally they would -- most of the decisions that affect that group's practice in this OR or that clinic would be some element of collective decision-making in an organizational democracy. 00:15:15.880 --> 00:15:42.073 And so, instead of the leader of those clinics or those work groups saying,"This is, what I figured out is the best way to do it so we're gonna do it that way." You first seek to understand, you listen, and you open the books with transparency so that people -- so you're not hiding anything unless it's, you know, confidential information. 00:15:42.140 --> 00:15:55.788 You build trust by being transparent, you build trust by first seeking to understand and to listen, and have the group, whenever it's appropriate, make the decisions together. 00:15:55.854 --> 00:16:11.736 So even if it's not 100% always consensus, everyone at least feels respected and their opinions and input was valued and they had an opportunity to make a, you know, decision, you know, be part of the decision-making. 00:16:11.803 --> 00:16:24.917 Most people will understand intuitively or after conversation that there probably needs to be some standard work, and if we need to start the ORs at 7:30 every morning, well then that's fine. 00:16:24.982 --> 00:16:26.284 That's not really negotiable. 00:16:26.351 --> 00:16:54.645 But there are -- But how can we have the group be informed and make decisions and -- It also includes for having the groups be physician led, and ideally they -- In some models they would have control or some input in who their next leader of this surgical group is, or this group of family docs is, so that it's a leader among peers. 00:16:54.712 --> 00:17:11.130 And so, I think those are some elements of organizational development that can help staff feel like they have some control over their work life because they're just not showing up and being told what to do. 00:17:11.195 --> 00:17:17.702 They have an opportunity to inform the decision or make the decision as a group. 00:17:17.769 --> 00:17:30.015 Yes, and I think this is actually very pertinent because I just read an article this morning that the employment status of a physician, specifically, is changing. 00:17:30.082 --> 00:17:42.193 The majority of physicians were self-employed just a decade ago and now 76% of physicians are employed in some shape or form in a bigger, larger organization. 00:17:42.260 --> 00:18:07.719 So these organizations, including ours, the Houston Methodist Physician Organization have responsibility to make sure that this agency, this control, this guidance, I would say, of physicians still exists in order to maintain, really, the best performance and the best wellbeing and happiness of our physicians. 00:18:07.786 --> 00:18:09.688 So this is really pertinent. 00:18:09.755 --> 00:18:13.157 The second thing you talked about is belonging. 00:18:13.224 --> 00:18:17.829 And, you know, it strikes me. 00:18:13.224 --> 00:18:17.829 I'm an immigrant, right? 00:18:17.895 --> 00:18:19.932 So I'm kind of, "Okay, well where do I belong? 00:18:19.998 --> 00:18:30.375

And where is home?" I lived in -- Only the United States I lived in three different states, which are very different from each other. 00:18:27.105 --> 00:18:30.375 So, you know, where do I belong? 00:18:30.442 --> 00:18:35.146 Where do people accept me? 00:18:30.442 --> 00:18:35.146 Where do I find my voice? 00:18:35.213 --> 00:18:45.390 And I think in health care, we have people that come for the mission, right, of caring for others, for advancing science, for advancing health. 00:18:45.457 --> 00:18:51.696 People come from all over the world, and specifically to the United States, and specifically here to the Texas Medical Center. 00:18:51.762 --> 00:18:54.665 You know, we are attracting people from all over the world. 00:18:54.732 --> 00:18:58.871 How can we make sure that they feel that they belong? 00:18:58.936 --> 00:19:04.375 Well, thank you for that story and that's exciting to hear that. 00:19:04.442 --> 00:19:13.050 The, I think -- In large part it starts with the leader of the smaller groups. 00:19:13.117 --> 00:19:29.433 The CEOs are really important and probably the most important leader in any organization for the… wellbeing of staff and particularly the belongingness of staff is the immediate direct report. 00:19:29.500 --> 00:19:37.542 There was a survey that Gallup did in 155 different countries and -- across the world, different cultures. 00:19:37.608 --> 00:19:41.445 And across all those cultures there was the same basic answer. 00:19:41.512 --> 00:19:52.124 If staff felt that their immediate report leader cared about them as a person, cared about them as a person, they thrived. 00:19:52.190 --> 00:20:01.299 They were much less likely to look for a different job, to leave, to -- they're much more likely to be engaged and productive, and happy. 00:20:01.365 --> 00:20:17.348 And so, the behaviors and the culture that that group leader sets, which is in large part set from the CEO down, but most of the staff, docs and nurses, don't interact with the CEO as much in large groups. 00:20:17.415 --> 00:20:31.262 So it's that immediate direct report leader making sure that they feel, staff feel welcome regardless of phenome or genome or how many states they've lived in their last ten years or whatever. 00:20:31.329 --> 00:20:34.967 And that's really important. 00:20:35.032 --> 00:20:40.872 There are ways you -- There are other programs you can put in place or practices. 00:20:40.939 --> 00:20:50.082 One of the important parts of being a human and well is sharing conversations and meals with other people. 00:20:50.147 --> 00:20:52.750 Oh I'm a big proponent of food. 00:20:52.817 --> 00:20:54.786 And meetings over lunch, and food. 00:20:54.853 --> 00:20:56.153 Yeah. 00:20:54.853 --> 00:20:56.153 DR. SCHAAL: Yes. 00:20:56.221 --> 00:21:01.759 Okay, I'm glad you're saying that so when we publish this episode I can actually quote you. 00:21:01.826 --> 00:21:09.500 Let's talk about this effervescence, collective effervescence and this notion

of harmony, energy. 00:21:09.567 --> 00:21:16.974 I think that's the easiest on your list because we are all driven by mission here in health care. 00:21:17.041 --> 00:21:19.911 I mean, people don't just choose health care as a career. 00:21:19.978 --> 00:21:29.354 They are somewhat, you know, deep inside passionate about it and feel very proud for making a difference in people's life. 00:21:29.421 --> 00:21:35.027 And sometimes taking care of the most vulnerable and the sickest patients that we have. 00:21:35.093 --> 00:21:49.875 Talk about how we propagate that shared purpose and really remind people what we do and not become, you know, not develop a callus around it. 00:21:49.941 --> 00:21:52.810 Thank you. 00:21:49.941 --> 00:21:52.810 I agree with you entirely. 00:21:52.877 --> 00:22:12.730 The -- This ikigai, this reason for being, this collective effervescence where we have this energy and harmony from working with other people with a shared purpose, it fits in this category of a calling with the work. 00:22:12.798 --> 00:22:22.473 And in health care I think, like you say, we have more of that intrinsic connection to the purpose at work than maybe other professions. 00:22:22.540 --> 00:22:40.692 It's also one of the -- It's one of those attributes of ideal work that can be eroded by misalignment of values with an organization or all the distractions that we put up with that weren't what you envisioned as this most meaningful job. 00:22:40.759 --> 00:22:45.529 So there're two things that I think are worth exploring here. 00:22:45.596 --> 00:22:58.042 One is when we look at drivers of burnout or moral distress, they vary dozens and dozens of ways depending on the individual. 00:22:58.109 --> 00:23:00.311 So the best way to find out about them is to ask them. 00:23:00.377 --> 00:23:13.325 You know, "What is your best day like, and what gets in between you and your best day?" And then you can address those systematically for that individual or the group. 00:23:13.391 --> 00:23:21.700 And it gets to this idea of job crafting and the literature is called job crafting, I like to call it life crafting. 00:23:21.767 --> 00:23:33.044 And it's basically -- First I was -- First learned about this when I was Department Chair and Chet Rihal was also the Chair of Cardiology at the time. 00:23:33.111 --> 00:23:57.134 And what He did when He visited with his staff on a regular basis, at least once a year he would ask them,"What brings you joy at work?" And everyone had an answer right away but most people came back, couple of them rolled their eyes, but most of them came back at their next meeting or in a couple weeks and said, "You know, Chet, I really appreciated that question. 00:23:57.201 --> 00:24:04.509 I thought about it and what really brings me joy at work is doing this type of surgery and this type of patient. 00:24:04.576 --> 00:24:10.781 Or, I love teaching, or I love my role as clinician investigator. 00:24:10.848 --> 00:24:12.851 Or I love quality improvement work." Whatever. 00:24:12.917 --> 00:24:21.326 And so, this encompasses the agency idea too where you have some control over your work life. 00:24:21.393 --> 00:24:40.612 What he would do and what the job crafting literature would suggest is that, well let's find a way that we can have you teach more or research, spend a little more time doing your research, or seeing this certain type of patient. 00:24:40.679 --> 00:24:51.056 And so, collectively the whole organization needs to do patient care, then we need to work on patience experience, we need to work on quality, we need to work on, you know, efficiency. 00:24:51.122 --> 00:24:54.491 We need to do elements of research and education. 00:24:54.558 --> 00:25:00.464 But everybody doesn't do -- So a clinician investigator, I was the same thing for my career. 00:25:00.531 --> 00:25:08.606 To have that balance it gives you some agency and, I think, increases your immunity to professional burnout. 00:25:08.673 --> 00:25:32.163 And so, what Tate and others found in a study of docs at Mayo was when a physician had spent about 20% of their time doing what they had self-declared as most meaningful to them, they had half the rates of burnout as doctors who weren't doing at least 20%. 00:25:32.230 --> 00:25:38.603 So -- and part of it is, you know, you actually change your allocation of what you're doing. 00:25:38.670 --> 00:25:42.574 Part of it's changing your perspective of what you're doing. 00:25:42.641 --> 00:25:48.512 And the third element or variable would be you could change with whom you are doing the work. 00:25:48.579 --> 00:25:50.682 And you have to be careful with that. 00:25:50.749 --> 00:26:05.195 But if I really enjoy doing research with you then let's figure out a way that we can do that together, and if I get to my 20%, I have half the rates of burnout of others. 00:26:05.262 --> 00:26:14.239 So job crafting is worth thinking about because then it's driven by individual docs saying this is what really brings me joy. 00:26:14.306 --> 00:26:23.714 And then as leaders we could help craft their schedules or change their perspective on how important the work they're doing is. 00:26:23.781 --> 00:26:30.454 And the forth thing you mentioned about ideal work environment, work place, is positivity. 00:26:30.521 --> 00:26:49.207 And I have to ask you, you know, in an era where health care is attacked and science is attacked, and on the other hand, the day-to-day life we have to take care of very sick patients. 00:26:49.273 --> 00:27:07.424 And, you know, sometimes we do our best and despite our best effort we are not successful, how does one maintain that positivity, that positive outlook, that sense that we're gonna be optimistic about the future? 00:27:07.491 --> 00:27:15.165 And more and more people would like to join us and, you know, become physicians, become nurses, become caregivers. 00:27:15.232 --> 00:27:19.003 How do we maintain that optimism as a profession?

00:27:19.069 --> 00:27:22.140 Well, two thoughts. 00:27:22.207 --> 00:27:26.310 So, I'll talk about Viktor Frankl then Carol Dweck. 00:27:26.377 --> 00:27:38.088 So, Viktor Frankl spent a couple years in Auschwitz, an unbelievably terrible place in the Nazi Germany concentration camps. 00:27:38.155 --> 00:27:55.839 And he saw that the people most likely to live were the ones that had something they were looking forward to, and that connected them with something meaningful and positive even if it wasn't until they got out of the concentration camp. 00:27:55.906 --> 00:27:59.676 And it turns out, we know, that ends up being true with epidemiology. 00:27:59.743 --> 00:28:01.880 But he observed that in Auschwitz. 00:28:01.945 --> 00:28:25.569 The other thing that he said in that regard is that they can take everything away except one thing, the last of the human freedoms to chose one's attitude in any given set of circumstance. 00:28:25.636 --> 00:28:31.308 So, this is something we all have control of in any set of circumstances. 00:28:31.375 --> 00:28:38.982 And the leader sets the tone of how terrible everything is or how good it can be. 00:28:39.049 --> 00:28:47.459 And yes, there are people who are disrespecting science and scientists, and research, and medical care. 00:28:47.525 --> 00:28:56.000 And they're a minority and we should focus on what we can control about the good stories, about the patients we helped. 00:28:56.067 --> 00:29:37.942 And I think the best way to keep the more positive work environment which is contagious within groups and between groups is by the leader behaviors of seeking to understand and appreciating and expressing gratitude, taking an interest in your career,"What do you wanna be doing five years from now at our hospital system and how can we work together for your dream to come true?" Fostering belonging so they could see that everybody on the whole team, the whole, beautiful spectrum of humanity is welcome and respected, and then transparency builds trust. 00:29:38.009 --> 00:29:45.616 So, the leader behaviors like that we studied at Mayo and other places now with over several hundred thousand responses. 00:29:45.682 --> 00:29:49.753 We started it in physicians and then scaled it to beyond that because it worked. 00:29:49.820 --> 00:30:01.132 Leaders that have those behaviors, their staff are more fulfilled, they're more satisfied, they're more likely to stay, and they have much lower rates of emotional exhaustion, professional burnout. 00:30:01.199 --> 00:30:19.116 So, something that dawns on me while we are chatting here is the importance of selecting the leader and then making sure that the leader, him or herself, are not burned out. 00:30:19.183 --> 00:30:25.222 Because sometimes you know, people seek, you know, leadership role, administrative role because they're burned out. 00:30:25.289 --> 00:30:33.830 And they say,"Okay, well I'm burned out from my clinical work, let me be a leader." Maybe we do not want these kind of leaders. 00:30:33.897 --> 00:30:47.578 Right, so I think that is -- that absolutely happens and we certainly wanna help those people but we wouldn't promote them to a leadership role if -- until they're well. 00:30:47.644 --> 00:30:52.750 So I think leadership selection, there are many ways to do it. 00:30:52.817 --> 00:30:56.554 I'll share with you one process that works. 00:30:56.621 --> 00:31:13.938 And it's not the only process that works but -- And so, I think that this model has the staff pick their own leaders in a co-selection process with senior leaders. 00:31:14.005 --> 00:31:34.759 And so, when Chet Rihal was selected as Chair of Cardiology the organization, doctors and -- outside of cardiology, met with every cardiologist one on one and asked them who they thought would be the best chair, two or three candidates, who would be the best chair to replace who preceded that person. 00:31:34.826 --> 00:31:38.496 And this is still the process at Mayo Clinic today? 00:31:35.926 --> 00:31:38.496 DR. SWENSEN: Still the process. 00:31:38.563 --> 00:31:44.836 And then the second question is, who would not be a good leader? 00:31:44.902 --> 00:31:45.670 Mm-hmm. 00:31:45.737 --> 00:31:55.779 And then they'd tally those up, those 100 interviews and the committee, it's a committee of doctors from other departments and administrators, to help out. 00:31:55.846 --> 00:32:13.364 And then they would get the top three that the staff said,"We have social capital with this relationship." And so they take three or four of the top candidates and then they would do a formal interview process with what's your vision and so and forth. 00:32:13.431 --> 00:32:19.537 They'd pick one and in -- So this co-selection starts them off on their right feet. 00:32:19.604 --> 00:32:37.087 The organization, those departments can already trust that leader and the organization says because they had a co-selection process, they say, "This person will also have an organizational view not just a cardiology view." And then the second element is there's a term limit. 00:32:37.154 --> 00:32:40.424 So no one at Mayo can serve more than 8 years. 00:32:40.490 --> 00:32:44.162 CEO, Department Chair, Dean. 00:32:44.228 --> 00:33:05.182 And every physician leader still practices medicine and they can do that because they have a dyad partner, a full time administrator, sometimes administrative team: finance, education, research, that helps in administrative and management tasks. 00:33:05.249 --> 00:33:14.959 And the physician -- physicians lead physicians and the physicians take care of the leadership aspect of that, and that allows them to lead as a team. 00:33:15.026 --> 00:33:21.898 There is a clear leader on that team and that's why they can still do surgery and they can still do, you know, bench research or whatever. 00:33:21.965 --> 00:33:25.068 Yeah, so, this is very unique to Mayo Clinic. 00:33:25.135 --> 00:33:29.807 I think it's not the case nationwide or worldwide.

00:33:29.874 --> 00:33:50.127 But one thing that we can learn from it is when we select or try to appoint a new leader over any part of our organization, it's really important to get the input of as many stakeholders as possible through interviews. 00:33:50.193 --> 00:34:02.740 And we want to attract, I think, not only our own people and make and appoint them, you know, and promote them, which we certainly would like to do, but we also want to attract people from the outside. 00:34:02.807 --> 00:34:05.609 But then how do we select? 00:34:02.807 --> 00:34:05.609 Who selects? 00:34:05.675 --> 00:34:21.759 I think that's, you know, everything that I hear you say point towards the importance of multiple stakeholders that are going to interview and are gonna give their feedback and their feedback is gonna matter. 00:34:19.724 --> 00:34:21.759 DR. SWENSEN: Exactly. 00:34:21.826 --> 00:34:24.795 So that's the principle behind it. 00:34:24.862 --> 00:34:27.030 Make sure I preface this, this is just one way. 00:34:27.097 --> 00:34:40.510 There are many ways that you can select leader and get out the principle of co-selection and feel like it was the staff that is to be led had a role in that selection process. 00:34:40.577 --> 00:34:43.280 The big picture goal is social capital. 00:34:43.347 --> 00:34:50.588 So you wanna build the trust and inter-relationship of all the people in the organization. 00:34:50.655 --> 00:35:12.909 And if they have some consultative role in selecting their leaders and those leaders listen to them authentically and connect them up over meals, connect them up over decision- making, then social capital grows and there's nothing stopping the organization. 00:35:12.976 --> 00:35:31.896 One question that I have to ask you about your recent published study,"Leading With Kindness," where you really developed a strategy for people to feel more satisfied in their work and have a meaningful career. 00:35:31.963 --> 00:35:40.438 And you put a spotlight on kindness there and you mentioned five kindness behaviors. 00:35:36.567 --> 00:35:40.438 What are those? 00:35:40.505 --> 00:36:06.264 So the idea behind the whole manuscript was to look at all the research that we know about organizational development and leader development and parse out the most successful systems and behavior, and structures, and processes that would drive us towards organizations with high social capital. 00:36:06.329 --> 00:36:12.168 It's driven by people respecting and wanting others to do better. 00:36:12.235 --> 00:36:27.784 And so it's that servant leadership idea of"I'm in this role to serve the staff that I have the privilege of leading so that they can best take care of patients and they're not there to serve me." And so that's the idea. 00:36:27.851 --> 00:36:35.793 And these fives behaviors are -- We measure them annually. 00:36:35.860 --> 00:36:54.411 Since 1981, we started our first all staff surveys and there're 12 questions about 5 behaviors that had huge impact in relationship with the wellbeing of staff, their satisfaction, fulfillment, and lower levels of emotional exhaustion, professional burnout. 00:36:54.478 --> 00:36:58.916 The five behaviors are not rocket science, they're common sense. 00:36:58.983 --> 00:37:07.992 And if they become common practice, one of the major elements of flourishing is in place for that. 00:37:08.059 --> 00:37:11.596 So, the five behaviors are first, seeking to understand. 00:37:11.661 --> 00:37:25.141 So, instead of -- If I know the answer about what we should be doing and I come in and tell the group, there's a -- We'll have a very different result than if we talk about it as a group and come to the same conclusion. 00:37:23.608 --> 00:37:25.141 DR. SCHAAL: Yeah. 00:37:25.208 --> 00:37:27.510 Basically listening, listening carefully. 00:37:27.577 --> 00:37:28.713 Okay. 00:37:27.577 --> 00:37:28.713 DR. SWENSEN: Yeah that's it. 00:37:28.778 --> 00:37:31.681 Yeah, listening carefully and authentically. 00:37:31.748 --> 00:37:53.103 The second is always looking for starting a meeting or weave it into gatherings, some element of appreciation of individuals or teams, and expressing gratitude to them in a way that is meaningful to them. 00:37:53.170 --> 00:37:57.675 Yeah, not forgetting that people actually work hard to deliver results. 00:37:57.742 --> 00:37:59.677 Great, what's next? 00:37:57.742 --> 00:37:59.677 DR. SWENSEN: Exactly. 00:37:59.744 --> 00:38:31.208 The mentorship piece, where you -- Each -- So the question that gets us,"Does my leader take an interest in my career?" And when you -- if you really care about someone as a person you'll be looking at helping them prepare for, have experiences with, develop for either another position or a different research project, or to be involved in quality improvement work. 00:38:31.275 --> 00:38:43.653 Whatever it is you -- whatever they would find most meaningful for their career to help them to work with them not do it for them, but with them. 00:38:43.721 --> 00:38:47.557 The fourth gets, basically, the belongingness. 00:38:47.625 --> 00:39:03.740 So leader behaviors are very important from body language to words, in having everyone feel accepted, and welcomed, and respected in those groups. 00:39:03.807 --> 00:39:07.344 And that basically, that's what drives the culture of an organization. 00:39:07.411 --> 00:39:11.047 And the fifth behavior is basically communicating with transparency. 00:39:11.114 --> 00:39:18.588 One of the most important things that we can do as leaders is to build trust. 00:39:18.655 --> 00:39:22.693 And if we open the books, then they can't say we're hiding anything from them. 00:39:22.760 --> 00:39:29.500 And we're building their respect by saying,"Here's what I know. 00:39:26.664 --> 00:39:29.500 Here's the information. 00:39:29.567 --> 00:39:39.610 Let's figure this out together." So this is fascinating, this leadership behavior that actually you track and you track for many years seeking to understand. 00:39:39.677 --> 00:39:55.092 Which means listening to people, appreciating people, mentoring people, and then accepting and respecting everybody on our team and then communicating, I would say, with honesty and transparency. 00:39:55.159 --> 00:39:56.659 That's wonderful. 00:39:56.726 --> 00:39:58.862 You know, I could talk to you all day. 00:39:58.929 --> 00:40:05.635 I'm learning a lot and really enjoying this but I have to ask you the last question on the podcast. 00:40:05.702 --> 00:40:16.514 Question that I ask everybody here, everybody that has graciously agreed to be my guest, and that is, what does quality mean to you? 00:40:16.579 --> 00:40:24.688 Quality has to be viewed through the eyes of the people we're serving, and so that starts with patients and the family. 00:40:24.755 --> 00:40:34.597 And so they own the definition of quality because they make the decisions about its presence or absence. 00:40:34.664 --> 00:40:41.572 I was a Chief Quality Officer at Mayo for the eight year term limit in 23 hospitals and I have a long definition. 00:40:41.639 --> 00:40:46.577 We had 110 metrics that we could measure about quality and safety. 00:40:46.643 --> 00:41:00.157 But at the end of the day, quality is what this patient with this background and these clothes and this medical condition or… sees and experiences. 00:41:00.224 --> 00:41:12.769 And so, if we start with the patient and work backwards from there in everything that we do then we will have the highest quality organization and we'll have the highest quality of staff. 00:41:12.836 --> 00:41:25.215 Because, we can't have the best experience, you know, comes for patients no matter how they define quality unless our staff is mentally, physically, socially, and spiritually well. 00:41:25.282 --> 00:41:26.217 Wonderful. 00:41:26.282 --> 00:41:29.652 That's a wonderful summary to this entire conversation. 00:41:29.719 --> 00:41:31.688 Thank you Dr. Stephen Swensen. 00:41:31.755 --> 00:41:34.257 I really enjoyed our conversation today. 00:41:34.324 --> 00:41:35.793 Yeah, I did too. 00:41:34.324 --> 00:41:35.793 Thank you very much. 00:41:35.860 --> 00:41:37.327 I appreciate it. 00:41:37.393 --> 00:41:39.630 And thank you for listening. 00:41:39.697 --> 00:41:46.202 Quality time is part of Houston Methodist's leading medicine series of physician led podcasts. 00:41:46.269 --> 00:41:50.974 So that you never miss an episode, subscribe to Quality Time. 00:41:51.041 --> 00:41:54.978 New episodes will download to your podcast device. 00:41:55.045 --> 00:42:02.887 If you enjoyed our conversation today please consider rating this episode and sharing it with your colleagues. 00:42:02.952 --> 00:42:05.822 I appreciate your support, thank you. 00:42:05.889 --> 00:42:09.193 And until next time, I am always listening. 00:42:09.793 --> 00:42:31.282 ♪ ♪